Key result
Intensive BP control is linked to higher hospitalization in frail patients but fewer falls in non-frail.
Why the study?
Randomised trials advocate for lower blood pressure, but this may cause adverse outcomes in frail older adults, and definitions of frailty vary.
Does intensive blood pressure control (<130/70 mmHg) increase adverse outcomes in frail older adults treated for hypertension?
Observational (n=1,920)
Does intensive blood pressure control (<130/70 mmHg) increase adverse outcomes in frail older adults treated for hypertension?
Different frailty classifications yield different prognostic implications for intensive blood pressure control in older adults, highlighting the need for standardized frailty assessment in hypertension guidelines.
Frailty phenotype may flag hospitalization risk with intensive BP control in older adults; leaves open standardized assessment and randomized confirmation in guidelines.
BACKGROUND: The 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines for management of hypertension in adults aged ≥65 years recommend a blood pressure (BP) treatment target of 130-139/70-79 mmHg if tolerated. Randomised controlled trials have advocated for lower BP, but this may have adverse outcomes in the frail. Yet, definitions of frailty vary. METHODS: Using a prospective, observational study design, we compared two frailty classifications in their ability to predict short-term adverse outcomes associated with intensive BP control (<130/70 mmHg) in The Irish Longitudinal Study on Ageing (TILDA). Data from participants aged ≥65 treated for hypertension in Wave 1 (W1) between October 2009 and June 2011 were analysed. Frailty was identified by Frailty Phenotype (FP) and the Clinical Frailty Scale (CFS). We formulated 8 participant groups based on frailty-BP combinations. Outcomes at wave 2 (W2) in 2012-2013 were analysed with adjusted binary logistic regression models. FINDINGS: Of 1920 W1 participants aged ≥65 and treated for hypertension, 1229 had full BP/FP and 1282 BP/CFS data. While the FP only identified risk of hospitalisation associated with intensive BP treatment, intensively treated frail-by-CFS participants had no increased or decreased risk of adverse outcomes, but those treated above the target had a higher risk of falls/fractures. In the non-frail by FP, intensive blood pressure treatment was associated with reduced risk of falls/fractures. INTERPRETATION: Different frailty classifications may have different prognostic implications for the purpose of the application of hypertension management guidelines. Our study had limited power due to low frailty prevalences, so further research is needed. Guidelines should specify the recommended frailty identification method/s. In the frail, therapy personalisation is needed.
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O’Donoghue et al. (2022) conducted an observational in Hypertension (n=1,920). Intensive blood pressure control vs. Above target blood pressure treatment was evaluated on Short-term adverse outcomes (including hospitalisation and falls/fractures). Intensive blood pressure control (<130/70 mmHg) was associated with increased hospitalization risk in frail patients defined by Frailty Phenotype, but reduced falls/fractures in non-frail patients.
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